How To Manage Obesity

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University of California Television (UCTV)

Жыл бұрын

Having a skilled primary care clinician will go a long way to maintaining your health and wellness. Join Dr. Diana Thiara as she explores weight loss and healthy living. From understanding the basics of BMI to the complexities of various weight loss methods, Dr. Thiara's insights will guide you through a comprehensive journey. Whether you're looking to shed some pounds, maintain a healthy lifestyle, or simply broaden your knowledge, her expertise covers dietary choices, surgical options, exercise routines, and even mental well-being. You'll also learn about personalized weight loss plans, the impact of genetics on weight, and how to make sustainable lifestyle changes. Drawing on her extensive experience and backed by the latest scientific research, Dr. Thiara offers a fresh and approachable perspective on weight management. Recorded on 03/22/2023. [7/2023] [Show ID: 38795]
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Пікірлер: 53

@uctv 6 ай бұрын

Check out "Nutrition and Cancer: Do’s and Don'ts" here: kzfaq.info/get/bejne/oMmEh7mm2Z2ciYU.html

@koenigxolo Жыл бұрын

It would be interesting to include the psychology of lifestyle changes.

@BartBVanBockstaele Жыл бұрын

That would be great, but I wonder whether that is possible in the current climate. Psychology is killed off in this area of medecine by the unfortunate claim that "it is not about willpower". While willpower is not the only thing, it is arguably the biggest thing.

@koenigxolo Жыл бұрын

@BartBVanBockstaele good point, that and "body positivity". Still, there must be something that could be useful from, say, addiction treatment programs.

@BartBVanBockstaele Жыл бұрын

@@koenigxolo I agree. Body positivity makes no sense. If one's body is so great, why change it? To make it even greater? What is so positive about a body that is in pain and suffering from any number of conditions caused by that overweight/obesity? Many (most/all?) addiction programmes suffer from the same problem we have here. They claim it is not about willpower while trying to convince someone not to use drugs. The only way a person is not going to use drugs, is if that person decides not to use drugs and sticks with that decision. That is willpower. So, how can one reasonably claim that it is not about the very thing that it is about? To me, that could possibly partly explain why addiction programmes have limited success. The only way around addiction without willpower is making sure the patient has no access. That is what residential programmes are about and it is just a friendly-sounding synonym for incarceration. And even these are sometimes/often being sabotaged by the patient's acquaintances because they bring in the toxic products the patient craves, and that is not to speak of the patient's "relapse" after coming out of incarceration. Those are not relapses, they are just availability issues. The patient was never cured in the first place. The one thing, I think, we can learn from addiction programmes is "abstinence". And abstinence needs willpower. It is arguably less painful than "moderation", but it is still willpower. In my view, and yes, it is nothing more than an opinion, lying to a patient is not a good strategy. Saying that it is not about willpower, is a blatant lie.

@andinianty Жыл бұрын

As one who's struggling with obesity for about 22 years, I've tried many weight loss methods lifestyle, exercise, calorie reduction, low carb,low fat and so on... none produced long lasting results. The temptation is too high and once you give in...like an addict I can't stop . My last hope is the surgery, and till now very satisfied with results , it changed my life ,I feel normal for the first time 😊

@BartBVanBockstaele Жыл бұрын

Congratulations with your success. You know this already, but I feel I should mention it anyway: please make sure to follow the guidelines you received for a sound and healthful diet and lifestyle. Many people regain the weight because they slip. The surgery is great for losing the weight and probably helpful for keeping it off, but self-discipline remains the major factor.

@presidioheights 8 ай бұрын

in many cases, surgery is the best solution for weight loss. but, you need to check with insurance to see if it has a requirement to go through less-invasive methods prior to surgery.

@andinianty 8 ай бұрын

@presidioheights Checked and did it, one year ago 😊

@guycoletta6466 Ай бұрын

@@BartBVanBockstaeleLess than 5% of people who try to lose weight by dieting are unable to to maintain that weight. Obesity is a metabolic disease with two known cures. Bariatric surgery and newer GLP1 medications. Dieting and lifestyle changes alone will NOT do it.

@BartBVanBockstaele Ай бұрын

@@guycoletta6466 I wouldn't know. I lost over half my body weight and seem to be keeping it off. So, I am obviously biased for it is impossible to ignore my weight loss. I did it without surgery, without any medication and without any other type of therapy. However, it did take me more than 40 years to find what I am doing, and I have no way of knowing if it would work for others, so I do not promote my diet. I only know it works for **me**.

@gregorymcmahan3914 Жыл бұрын

Great talk. Lots of useful nuggets. On that score, here are the most important: 1. There is no way around lifestyle change for weight maintenance and weight loss. 2. Although the good doctor hid behind a bit of scientific verbiage, the result is damning: the people chosen for the various weight loss drug studies are NOT representative of the type of people who will ultimately be taking the weight loss drugs (there's a glaring self-selection problem in the study designs to the trained bio-statistical eye). That said, the various weight loss drugs do NOT work as expected or intended for the vast majority of the people taking them. Stated another way, the people who end up taking them do not take them under the exact same conditions/protocols as the clinical study participants, and therefore, people in the general public rarely see similar results as the participants in the clinical studies. Big hint: roughly half the weight loss (in percentage terms) seen on the drugs in participants in the trial came from the drug, and the other half came from lifestyle changes. Thus, we are led back to the first conclusion: there's no way around lifestyle changes for weight maintenance and weight loss. All that said, I cannot say that the drugs don't work. What I can say is that for most people taking them, it comes as no surprise to me that the drugs rarely work in the manner expected. Sure, the drugs promote short-term weight loss. Problem is, the weight loss ceases when you come off the drugs and it is hard to sustain use of the drugs (and the weight loss achieved as a result). And this is BEFORE you consider the side effects while on the drug (which often forces people to stop taking them) and the as-yet-unknown (or perhaps better put, UNSTATED) deleterious effects the drugs may well have on other aspects of your health; every single other weight loss drug has had deleterious health effects, so why should we expect these new weight loss drugs to be any different?. The bottom line for me personally is this: I will be taking a hard pass on the drugs and the surgeries, and I will stick to a program of focused and determined permanent lifestyle change that is simple, safe and sustainable. My approach may well take a lot longer, and will definitely not produce outstanding results in the short term, but I won't be putting my health at risk as a result.

@Anthony424766a Жыл бұрын

Obesity I know must be eliminated and/or controlled through the following changes in habits: 1. Eliminate the intake of sugar and fructose. This includes added sugar in processed foods. 2. Eliminate the consumption of refined carbohydrates (wheat flour, bread, rice, etc.) 3. Consume healthy fats. 4. Eat real (natural) foods. 5. Carry out intermittent fasting controlled by a specialist nutritionist, endocrinologist and cardiologist. 6. Do daily exercise routines (walks or other exercises) 7. Control blood sugar, glycerin, triglycerides and cholesterol. Check Glycosylated Hemoglobin (H1cb).

@DrAnandRamanTiwari Жыл бұрын

Thanks for such a wonderful session 😊

@dreeem_sa Жыл бұрын

there is no calorie-free fiber but in very small proportions This is what I think and I may be wrong

@BartBVanBockstaele Жыл бұрын

You are correct. What we call "dietary fibre" gives us energy. It is estimated at 2 to 2.5 kcal per gramme, i.e. about half of the average for "digestible" carbohydrates. However, if it is true that Americans only ingest about 15 grammes of fibre, that amount of energy (30-37.5 kcal) is clinically irrelevant. On the other hand, if you consume larger amounts, such as people who eat only minimally processed plants, fibre amounts can easily rise to 100 grammes a day or more. In that case, that would be far from negligible. Of course, there is also the not-so-minimall processed fibre such as inulin supplements or psyllium fibre and that can lead to a rather substantial intake (without much benefit, and often with non-negligible undesirable effects).

@belindacoleman9662 Жыл бұрын

This was very informative and helpful for me. I have a better understanding of what my lifestyle change must include; which is a nutritious diet and a reduction of calories. I clearly understand what is needed to be successful with the initial weight loss. Plus, I have a definitive plan for the maintenence of the initial weight loss over time. I have experienced a couple weight loss, twice. But, I could not maintain it; over a long period of time. Now, I know exactly why. Thank you for this video. The timing was perfect. Peace and Blessings

@ms.q7445 Жыл бұрын

Good luck to you, wishing you lots of success!

@lohphat Жыл бұрын

Calories aren’t the problem, sugars are the problem. Calories are the wrong metric as sugars and fats are digested differently. I was in a high fat, low carb diet and lost 30 lbs in 3 months. Fats are higher in calories but are digested at a much lower percentage than sugars. E.g. alcohol by definition are high in calories but your body can’t digest alcohol for those calories. It just breaks the alcohol sugars down into acetal-aldehydes by the liver and excreted. Ignore calories. Reduce carbs.

@BartBVanBockstaele Жыл бұрын

@@lohphat It is great that a high-fat diet worked for you, but it does not work the way you think it does. The difference in calories burned between sugar and fat is minimal. It was once thought that fat required so much energy that it was actually less energetic than sugar. That was in the late 70s, early 80s, but has been thoroughly debunked since. Fat and sugar are virtually identical in their percentages. Unless you are one of a very small number of exceptions, you will see in the not-so-distant future that your weight comes back, probably accompanied by a number of metabolic problems caused by your excess fat consumption. It is perfectly possible to lose weight on sugar. You may want to check out Prof. Haub's "Twinkie diet" and Prof. Kempner's once world-famous "Rice diet" that had spectacular results.

@lohphat Жыл бұрын

@@BartBVanBockstaele I've been on the diet for 6 years. The weight has not returned, my a1c levels are normal and i had a CAC CT scan and my coronary arteries are clear. I'm not "misinformed", I listen to university-affiliated physicians and research. Biochemistry is fact-based, not by opinion.

@BartBVanBockstaele Жыл бұрын

@@lohphat Well then, congratulations. You are part of a tiny minority. Not even Dr. Atkins was able to do it. As for biochemistry being fact-based, it is. That is why the claim that calories are the wrong metric is wrong. It would also be wrong to claim they are the only metric that matters, but they are the fundamental one. You cannot possibly do the work of 2000 kcal when you only ingest 1000 kcal. That is just as true as with cars. You cannot possibly do the work of 100 litres with 50 litres. Sure, you can drive more slowly, you can switch off the airconditioner, the radio, whatever, and you will go a little farther, but ... when you are out of gas, you are not going anywhere. The same is true for calories as used in biology. It is, by the way, why I don't like the Atwater factors. They are estimates, averages, rules of thumb, reasonably good ones, but still estimates. What I want, is bomb calorimeter values. While our technology to measure them is not exact (no method of measuring in existence is exact), they are more than precise enough. The advantage of bomb calorimeter values is that they give you "maximum availability". The reason this is helpful for weightloss is that you short-circuit the entire "calorie is not a calorie" circus. By concentrating on calories (scientists use Joules, actually), you look at the big picture without wasting time on minutiae. One person who demonstrated that quite clearly, is Prof. Haub with his (in)famous "Twinkie diet". He is on KZfaq. There are other versions as well, but his is a good start. And no, he does not recommend it. He did it to make a point that so many people do not seem to understand. As you said, biochemistry is based on facts, but the facts of biochemistry are controlled by the facts of physics. That is the hierarchy: all biochemistry is physics, but not all physics is biochemistry. Biochemistry is a subset of physics. And that is why calories are the fundamental value.

@L.Spencer 11 ай бұрын

I've been on an actual diet once, done by using a Curves meal plan from a book. It was pretty hard, did lose some weight, mostly learned how little one needs to eat to lose weight. The times I've lost weight has been unintentionally during extreme times of stress, once when I had an anal fissure and everything I ate would end up hurting me. Stress and anxiety make my appetite disappear. I think I have sugar addiction. I've started some good habits, but need to work on really cutting out sugar. Thanks for this video, it gives a great overview. But it also makes me think I'll never lose weight and keep it off.

@ryarya3291 Жыл бұрын

What can I do if I cant digest fibers and whole grains? Thx

@BartBVanBockstaele Жыл бұрын

Actually, you can almost certainly digest both. Talk to a doctor who knows you well and ask what to do. Standard advice is to start with very small quantities and slowly increase quantities. The idea is to let your digestive tract get used to fibre again. Just don't try it on your own without medical advice.

@charletestes2299 Жыл бұрын

Question, I have been on 1200cal for over a year, lost 72lb. My metabolism is slowing, I can feel it and if i go to 1700 cal, i gain. Surely the human body has an adaptation that would kick in and allow a person to return to, at the least, nutritionally sound eating habits? Nature would not have us simply continue cutting and cutting in order to maintain, until we simply died of malnutrition? If you stay on maintenance long enough, can you add a few calories? That seems to me to be what these diet coaches should concentrate on, maintenance, but then, that would cut out the meds and surguries, and eventually the coaches i guess

@tforan4093 Жыл бұрын

Is it true that an individual's "set point" will make it nearly impossible to keep weight off over the long term?

@BartBVanBockstaele Жыл бұрын

No. And there is ample proof of that. What is true, is that the majority of people do not keep the weight off. Regardless of the populist claims, it is a matter of two elements: a little bit of (very important) knowledge and a lot of self-discipline. The last bit becomes easier over time but (almost certainly) never goes down to zero. There is, as far as I know, no credible evidence for the set point hypothesis.

@tforan4093 Жыл бұрын

@@BartBVanBockstaele Set point is also mentioned at 34:17 in the video.

@BartBVanBockstaele Жыл бұрын

@@tforan4093 I listened to that part, but unless I missed it again, she talked about homeostasis, not set point. They are not the same, even if they "smell" similar. As far as I have been able to find out, set point was once a valid hypothesis, but was never proven and is now mainly used as an excuse to explain why someone cannot keep the weight off unless they use some miracle method that the claimant just happens to sell.

@tforan4093 Жыл бұрын

@@BartBVanBockstaele So you think self discipline is key? If so, why is self discipline so hard for many people?

@BartBVanBockstaele Жыл бұрын

@@tforan4093 Yes, I do. While losing weight is really simple, it is also incredibly hard. Worse, it is supposed to be hard. It is also why there is insistance on "lifestyle changes". While it is just another name for diet, it is seen as a way to tell people that this is forever, not something you do for a while, after which you go back to your old lifestyle, without using the "self-discipline" term. Many people erroneously think they can go back, but they are completely wrong, since their old lifestyle is what got them fat in the first place. If one wants to lose weight and keep it off, one has to wave goodbye to one's old lifestyle forever. That means self-discipline, i.e. the determination (the speaker uses the word "commitment") to stay on track, not giving in to temptation and not veering off. Self-discipline has become a taboo word but I know of no other word that accurately describes the fact that one has to maintain the new lifestyle.

@rahky2799 Жыл бұрын

What about the gastric balloon?

@proudchristian77 Жыл бұрын

Your tummy is a organ it expands & shrinks down according to what & how much we feed it & how much we move around, if we don't move around our food sits on us , y i move around, 🚲

@charletestes2299 Жыл бұрын

The main objection I have to the BMI scale is the fact that it doesn't apply to everybody and they want to apply it to everybody across the board. For example, I am 5 ft 6 in tall I weigh 155 lb which makes me in the overweight BMI category however, I am grossly underweight from the waist of my ribs show, I am sending to the point of of being painful if I'm even touched anywhere in the rib cage area anywhere in the stomach area anywhere on my back and that is due to over dieting trying to get below the recommended BMI. Where the problem comes in is that I carry all of my weight in my thighs and on my legs between the area of my groin and my knees I have considerable cussing on my knees and I have considerable what they used to call back in the 1970s, saddlebags. My legs are puffy, they swell and they have a I guess what people call A Mattress E look to them, back in the 70s when I was a kid they used to call it cellulite but I guess it is not cellulite and I am able to lose weight everywhere except there. Therefore I'm still considered overweight, a few months ago I was considered morbidly obese even though I am technically underweight everywhere except that one section of each of my legs! So the BMI should not apply in that manner it's like trying to put everybody in a box, trying to categorize everybody and make everybody in a cute little package it doesn't work that way😢

@BartBVanBockstaele Жыл бұрын

You are right. It does not apply to everybody. It was also not created for that. It was a way, created by a 19th century statistician (Adolphe Quételet) to study populations, not individuals. Despite its simplicity and inherently flawed nature, it is actually astonishingly good for its purpose. The way it is used in North America is a perversion of its purpose. It is therefore not the BMI that is at fault, but the lack of statistical insights of those who use it.

@charletestes2299 Жыл бұрын

@@BartBVanBockstaele absolutely. Thank you!

@BartBVanBockstaele Жыл бұрын

7:53 "Fibre and water don't have calories." While that is true for water, it is false for fibre. Fibre does have calories, and it is estimated at 2 - 2.5 kcal per gramme on average. That is not some high-level secret. It is distressing to see that the myth of calorie-free fibre continues to be propagated at university level.

@missprimrose4132 Жыл бұрын

❤true!

@maggieadams8600 Жыл бұрын

$1400.00's for a month's for medication that might help you lose a little more weight providing you change your lifestyle. Just change your lifestyle and save yourself $1400.00's a month, whilst still losing weight! I wouldn't touch those drugs if they were free!

@BartBVanBockstaele Жыл бұрын

There is something to be said for that, but losing weight and keeping it off is really hard for most people (and to make it worse, it is supposed to be), so the help given by the drugs can be a life saver. We should not forget that this is not about a choice between good and bad. Being overweight or obese is dangerous. If medication can help reduce that situation, it may well be worth the risks and the money. That is even more true when we consider that numberless people are willing to have their intestines rearranged to achieve weight loss, despite the risks and the significant probability that it will be in vain due to weight regain in the long term (which may well happen with the medications as well, we just don't know that yet).

@maggieadams8600 Жыл бұрын

@@BartBVanBockstaele True, plus, if I had to pay $1400.00's a month for that medication, I would definitely lose weight, I'd first become homeless after which I'd starve to death, because it's more than I earn by a mile. I'd also contribute to the profits of the drug companies, who's members might then over eat to such an extent, bought about by their already, insatiable greed, that they, in turn, grow so obese that they all lay down and die.

@BartBVanBockstaele Жыл бұрын

@@maggieadams8600 It's a Rube Goldberg system! You are right, though. So, in order to kill off Big Pharma, we should all buy their antiobesity drugs .